Provider Demographics
NPI:1861522575
Name:REICH, MARVIN (MD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:
Last Name:REICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6071 NW 43RD TER
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-4044
Mailing Address - Country:US
Mailing Address - Phone:561-427-7997
Mailing Address - Fax:
Practice Address - Street 1:6071 NW 43RD TER
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-4044
Practice Address - Country:US
Practice Address - Phone:561-427-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051631207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374420500Medicaid
FLK2795Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
FL374420500Medicaid